Trimethylamine‐N‐oxide is elevated in the acute phase after ischaemic stroke and decreases within the first days

Abstract

Background and purpose Trimethylamine‐N‐oxide (TMAO) is a biomarker of the gut microbiome and correlates with the risk of cardiovascular diseases. However, conflicting data exist on the specific role of TMAO in ischaemic stroke patients. We aimed to analyze the time course of TMAO levels in stroke patients compared with controls. Methods In this prospective, case‐control study, patients suffering from ischaemic stroke (onset <24 h) and control patients with less than two cardiovascular risk factors were enrolled. Plasma TMAO levels were analyzed on admission, after 48 h and after 3 months. The primary endpoint was the difference in TMAO levels on admission between stroke patients and controls. Results A total of 196 patients with ischaemic stroke and 100 controls were included between February 2018 and April 2019. Plasma TMAO levels on admission were significantly higher in stroke patients than in controls [median value 4.09 (2.87–6.49) vs. 3.16 (2.08–5.16) µmol/L, P = 0.001]. There was a significant decrease in TMAO levels in stroke patients after 48 h [median at 48 h, 3.49 (2.30–5.39) µmol/L, P = 0.027]. TMAO levels increased again 3 months after stroke [median 4.23 (2.92–8.13) µmol/L, P = 0.047]. In controls, TMAO levels did not change between admission and after 48 h [median at 48 h, 3.14 (1.63–4.61) µmol/L, P = 0.11]. An inverse correlation between TMAO values and kidney function was found (Spearman rho −0.334, P < 0.001). Conclusions Our study emphasizes the importance of the time course of TMAO levels after ischaemic stroke. Future studies should define the time point of TMAO analysis, preferably in the acute phase (<24 h).

Trimethylamine-N-Oxide Levels Are Similar in Asymptomatic vs. Symptomatic Cerebrovascular Atherosclerosis

“…Our results are in line with a recent study (7), which included 296 patients (196 patients with ischemic stroke and 100 patients with a low cardiovascular risk profile). TMAO levels were significantly higher in stroke patients compared to controls, but there was no difference between patients with different stroke etiologies.…”

“…Moreover, the number of patients is relatively small as we set out to obtain the plasma sample of patients immediately on admission in the emergency room. Previous studies have shown that the timing of TMAO measurement is paramount (7,17). We do not have any follow-up data on the patients with asymptomatic cerebrovascular atherosclerosis, so that we cannot answer the question, whether TMAO would predict future cerebrovascular events.…”

“…Some results of patients in this study have already been published as part of a study on TMAO levels in patients with and without ischemic stroke (7).…”

Trimethylamine N-oxide in atrial fibrillation progression

“…TMAO was measured using electrospray ionization tandem mass spectrometry according to a modified protocol of Wang et al [4] . The modifications are described by Schneider et al [4] .…”

“…TMAO was measured using electrospray ionization tandem mass spectrometry according to a modified protocol of Wang et al [4] . The modifications are described by Schneider et al [4] . In brief, plasma samples were prepared according to Wang et al with minor modifications: 10 µL samples were pipeted into a 1.5 ml centrifuge tube.…”